Background: Exponential use of internet has resulted in internet addiction in recent times. Students are particularly at risk because of their unique personal, social, and academic needs. Objectives: The study was designed to evaluate the prevalence of internet addiction and its determinants among medical students. Materials and Methods: A cross-sectional study was conducted in 282 medical students with the help of semi-structured questionnaire consisting of questions related to demographic information, information related to internet use, and Young's internet addiction test. Results: We found prevalence of internet addiction among medical students to be 58.87% (mild – 51.42%, moderate –7.45%) and significantly associated factors with internet addiction being male gender, staying in private accommodation, lesser age of first internet use, using mobile for internet access, higher expenditure on internet, staying online for longer time, and using internet for social networking, online videos, and watching website with sexual content. Conclusion: Medical students are vulnerable for internet addiction and efforts should be taken to increase awareness and prevent the problem of internet addiction in them.

The beginning of the 21st century has witnessed an explosive growth of internet usage worldwide, particularly in the developing countries such as India. Originally devised for information exchange and research purpose, internet has literally percolated every aspect of human life including social communication, education, research, health seeking, banking, business, shopping, administration, and entertainment. So much so that internet has been an essential part of our lives and today, we cannot imagine our lives without internet. Globally, internet users have already crossed three billion marks while in India, internet user base grew over 17% in the first six months of 2015 to 354 million.[1]

Indeed, this progress has made our lives easy and enriched, but it also has the other side effects. Internet can be misused and excess internet use can be pathological and addictive.[2] This maladaptive use of internet has been referred by different labels by different researchers such as internet addiction,[3],[4] internet addiction disorder,[5] pathological internet use,[6],[7] or Internet dependency.[8] Though the adverse effects of excess internet activities were recognized earlier, internet addiction was recognized as a psychological disorder only in the mid-1990s.[9] Since then, it has been considered a subset of behavioral addictions and has drawn a considerable attention of researchers.[10] Though internet addiction has not been included in Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, internet gaming disorder has been included in the section of “condition for further study.”[11]

Studies have shown that internet addiction is a worldwide phenomenon and its prevalence varied greatly from 03% to 38% depending on the population studied, methodology of the study, and diagnostic instrument used.[12] Researchers have also shown that younger population and especially college students are more vulnerable because of their psychosocial and environmental characteristics.[13],[14] Several factors have been attributed to this vulnerability. First, students have larger proportion of unstructured time when they can use internet. Second, students may have unlimited access to internet provided by universities through Wi-Fi. Many times students are encouraged by their teachers to use internet for academic purposes. Third, young students have more urge to use the latest gadgets and technologies as well as the latest application available on internet. Fourth, young students have less parental control and censoring of what they do online. Fifth, being young, students have their own developmental needs. Among these important are developing a sense of identity and developing meaningful and intimate relationship.[15] Being a virtual mode of social interaction, internet allows its user to expand the range of emotions expressed toward others. This makes internet a suitable mode of social interactions rather than face to face interactions. Hence, many young students tend to make friendships and intimate relationships online.

This internet addiction can lead to various psychological, physical, as well as social, problems including impaired function at work, impaired academic performance, sleep deprivation, poor dietary habits, headache, eye strain, social isolation, and relationship problems.[16],[17],[18] Internet addiction has also been found to be significantly associated with some psychiatric disorders such as alcohol abuse, attention deficit and hyperactivity, depression, and anxiety.[19]

Researchers have tried to find out the determinants or risk factors associated with internet addiction, and it has been proposed that certain personal, familial, social characteristics as well as certain internet-related factors are contributing toward internet addiction. Male gender,[8],[9] initial course years, permanently logged in status, peer influence, preference for virtual interaction with friends; and using the Internet for chatting, pornography, making new friendships, getting into relationships online, and shopping;[20] time spent on internet per day, mode of accessing internet,[9] speed of internet, accessibility, and intensity of information accessed online [21] were some of the factors found to be associated with internet addiction. It is in this context that the present study was undertaken to explore the ever increasing problem of internet addiction among medical students (since they are the future medical professionals who are likely to come across the addicted patients) with the aim to:

Evaluate the prevalence of internet addiction among medical students and toEvaluate association of personal, familial, social, and internet-related factors with internet addiction.

Materials and Methods

A cross-sectional analytical study was carried out among undergraduate medical (MBBS) students in a medical college in an urban area of Western Maharashtra after approval from Institutional Ethics Committee; a total number of 300 students were included in the study. Students were enrolled by two stage sampling. First, the students were stratified according to their year of academic course, i.e., 1st , 2nd, and 3rd year, and then, the required numbers of participants were selected by simple random sampling method from each group so that each academic year will have equal representation in a study sample. Only students who gave informed consent and who have been using internet for at least for 6 months prior to the study were included in the study. Participants were assured that the information given by them would be anonymous and confidential to avoid reporting bias.

The data were collected using self-administered semi-structured questionnaire consisting of information about demographic data, information about internet usage, and internet addiction test scale developed by Dr. Kimberly Young.[22] Young's internet addiction test is a self-rated scale developed for screening and measuring level of internet addiction and has been used extensively for this purpose worldwide. It contains twenty questions related to internet usage to be scored on Likert scale from 1 (rarely) to 5 (always). A total score of <20 represent normal user, between 20 and 49 represent mild addiction, between 50 and 79 represent moderate addiction, between 80 and 100 severe addiction. The validity and reliability of Young's internet addiction scale has been tested in many studies.[23],[24] Its reliability in Indian population and college students has also been established.[9],[20]

Statistical analysis of data was carried out by using SPSS and Chi-square test to analyze qualitative variables, and one-way ANOVA to analyze quantitative variables. A value of P<0.05 was considered significant for all statistical correlations.

Results

Of 300 questionnaires distributed, 282 were taken for further analysis as 18 students did not fill up the questionnaire completely. Of 282 students, 122 (43.26%) were male while 160 (56.74%) were female. The mean age of study sample was 19.90 ± 1.37, the range being 17–24. Among participating students 93 (32.98%), 95 (33.69%), and 94 (33.33%) were studying in 1st, 2nd, and 3rd year, respectively. The mean length of internet use was 3.34 ± 1.80 h/day, the range being 30 min to 12 h. Of 282 students, 116 (41.13%) students were not having any internet addiction while 166 (58.87%) students were having internet addiction, out of which 145 (51.42%) were mild addicts while 21 (7.45%) were moderate addicts. There was no severely addict student.

[Table 1] shows the relationship between demographic variables and internet addiction. It shows that variables such as gender and place of current stay of student have significant association with internet addiction. Males are more addicted to internet than females (P = 0.00003). About 72.95% of males were addicted to internet as compared to 48.13% of females. Students staying in private accommodation were more addicted to internet as compared to students staying in their home with parents and those staying in hostel (P = 0.0169).{Table 1}

[Table 2] shows the correlation between internet use pattern variables and internet addiction. Age at which internet was first used, gadget used for internet access, monthly expenditure on internet, and hours spend on internet per day were significantly associated with internet addiction. Lower age of the first internet use was associated with internet addiction (P < 0.0001). Using mobile for internet access was more associated with internet addiction compared to desk- and lap-top use for internet access (P = 0.0002). More monthly expenditure on the internet (P = 0.00002) and more time spent daily on the internet (P < 0.0001) are also found to be significantly associated with internet addiction.{Table 2}

The present study investigated the problem of internet addiction among medical students. We found that 58.87% of the medical students had internet addiction. About 51.42% of the students were mildly addicted while 7.45% of the students were moderately addicted to the internet. The finding is comparable with the prevalence of 56.6% as reported by Duraimurugan et al.[9] in a study among college students from South India. They found 41.3% to be mild addicts while 15.2% to be moderate addicts. In another study, Sharma et al.[14] reported 42.7% prevalence of internet addiction, 35% was mild, 7.4% moderate, and 0.3% severe addict professional college students in India. However, some studies have also shown lower prevalence of internet addiction. A study on Turkish college students [25] showed prevalence of internet addiction to be 9.7% while in a study among Iranian medical students,[26] the prevalence was 10.8%. The variation in prevalence can be attributed to heterogeneity of study samples and different diagnostic tools used.

In the present study, males were found to be more addicted compared to females. The finding has been corroborated by many previous researchers including Duraimurugan et al.[9] and Sharma et al.[14] Morahan-Martin and Schumacker [7] explained this gender difference with a reason that males involve more in online activities such as gaming, pornography, and gambling which can lead to pathological internet use. The study also revealed that students staying in private accommodation are more prone to internet addiction as compared to those staying in hostel and home. This finding is in accordance with the finding by Asiri et al.[27] which also predicted that the internet addiction score is higher in students staying alone. The reasons might be loneliness, privacy for internet activities, and lack of supervision.

The lower age of initiation of internet use was found to be associated with internet addiction. Researchers have mentioned that early exposure to internet activities can increase the risk of internet addiction.[28] Adolescents may use internet as a coping mechanism to deal with the adjustment problems in early transition years, and this coping may persist in later age to develop in internet addiction. We also found that mobile use for internet access was associated with internet addiction. At present, available smartphones may provide individual with an opportunity to have easy and continuous access to internet which may lead to excess and unintended use of internet.

In our study, internet addict students found to spend significantly greater amount and time on internet as compared to nonaddicts. This finding correlates with the previous studies.[29] Greater expenditure of money and time among internet addicts may lead to financial problems and distraction from academic achievements.

Using internet for social networking, watching videos, and visiting websites with sexual content were significantly associated with internet addiction. Similar findings have been reported by other researchers.[7],[9] Social networking has become new age fad. Anonymous nature of online interactions, achieving altered sense of personal identity online, and need for developing intimate relationships can be the reasons for excess internet use for social networking. Watching adults only material online for sexual fulfillment can also lead to pathological internet use.[7]

Conclusion

The present study unfolds that internet addiction in the majority of the medical students is a dark reality that requires timely remedial action. Detection of internet addiction therefore assumes greater importance in professional institutions such as medical colleges. Hence, the internet addiction among students should be given more attention and a comprehensive program for students should be prepared to increase awareness of the internet addiction among students and faculties of college, to detect students at risk before it becomes pathological. It needs to be emphasized that students will have to be educated in safe and healthy practices for internet use.

Limitations

Our data collection was based on self-reporting of symptoms by the students, and we did not conduct any interview with students to confirm the clinical diagnosis of internet addiction. Being a cross-sectional analysis, although we found factors associated with internet addiction, the cause and effect relationship between associated factors and internet addiction could not be established. An observational, longitudinal study would give more information on the prevalence of addiction.

Krishnamurthy S, Chetlapalli SK. Internet addiction: Prevalence and risk factors: A cross-sectional study among college students in Bengaluru, the Silicon Valley of India. Indian J Public Health 2015;59:115-21.